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Applied Ergonomics 36 (2005) 193–198


www.elsevier.com/locate/apergo

Schoolbag weight and musculoskeletal symptoms in New Zealand


secondary schools
J. Whittfield, S.J. Legg, D.I. Hedderley
Centre for Ergonomics, Occupational Safety and Health, Department of Human Resource Management, College of Business, Massey University,
Private Bag 1122, Palmerston North, New Zeland
Received 18 September 2000; accepted 27 October 2004

Abstract

The weight of schoolbags and the prevalence of musculoskeletal symptoms amongst 140 students (70 third form students
comprising 35 females and 35 males, and 70 sixth form students comprising 35 females and 35 males) from five New Zealand
secondary schools was investigated. Schoolbag weight for third form students (mean age 13.6 years) was 13.2% of their body weight,
while for sixth form students (mean age 17.1 years) it was 10.3% of their body weight. These weights may exceed the recommended
guideline load limits for adult industrial workers. Musculoskeletal symptoms were reported by 77.1% of the students. Symptoms
were most prevalent in the neck, shoulders, upper back and lower back. Although musculoskeletal symptoms are believed to be
multifactorial in origin, the carriage of heavy schoolbags is a suspected contributory factor and may represent an overlooked daily
physical stress for New Zealand secondary school students.
r 2004 Elsevier Ltd. All rights reserved.

Keywords: Load carriage; Back pain; Children

1. Introduction investigated the effect of backpacks and athletic bags


which were loaded with 17% of students body weight.
Only a handful of studies have investigated the weight They concluded that the carriage of schoolbags sig-
of schoolbags, and the impact of schoolbag carriage on nificantly altered the posture and gait of students and
the musculoskeletal systems of school students. Voll and suggested that it may lead to a variety of musculoske-
Klimt (1977) found the relative weight of schoolbags of letal complaints such as muscle soreness, back pain,
first graders to be 11.1% of body weight, 12.5% for the numbness and shoulder pain. More recently, Negrini et
second graders, and for the third and fourth graders al. (1999) found the average load carried by year 6
between 12.5% and 14.3%. The National Back Pain (mean age 11.6 years) Italian schoolchildren was 9.3 kg
Association (1997) recorded schoolbag weights for (22.0% of body weight), and suggested that a decrease
British children and found that 13-year olds carried in the load carried is advisable as rates of low back pain
10.4% of their body weight, and 16-year olds 10.2%. in children are approaching those seen in adults.
Malhotra and Sen Gupta (1965) assessed the impact of However, no assessment of pain or discomfort was
schoolbag carriage using schoolbags weighing 6 lb, undertaken in this study. Whittfield et al. (2001) also
which represented approximately 10–12% of the body investigated the weight and use of schoolbags, this time
weight of the students investigated. Pascoe et al. (1977) in New Zealand schools, but the impact of schoolbag
carriage on the musculoskeletal systems of school
Corresponding author. Tel.: +64 6 350 5799x2786; fax:
students was not outlined.
+64 6 350 5796. There have been many attempts to establish safe load
E-mail address: s.j.legg@massey.ac.nz (S.J. Legg). carriage limits (Snook, 1978; Jiang and Ayoub, 1987;

0003-6870/$ - see front matter r 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.apergo.2004.10.004
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194 J. Whittfield et al. / Applied Ergonomics 36 (2005) 193–198

Snook and Ciriello, 1991; Waters et al., 1993). However, a representative cross section of Auckland secondary
the concept of a maximum safe weight implies that there schools. An explanation of the procedures of the study
is an identifiable cut-off point beyond which the levels of was given and all subjects signed a consent form which
risk become unacceptable (Pheasant, 1991). The New indicated their voluntary participation. Data were
Zealand Department of Labour Guidelines (1991) collected on an unscheduled day so that students could
indicated that weight should not be used to prescribe not alter their schoolbag weight. The height and body
absolute limits, but should instead be considered as just weight of each student was measured, as were the weight
one of the important factors to be taken into account of their schoolbags and the weight of any additional
when assessing risk in load carriage. While this seems items that they carried. Height was measured using a
logical, guideline load limits may be useful in providing portable stadiometer (manufactured by ‘Medizintech-
a base from which to begin to assess a load carriage nik’). Body weight was measured with electronic scales
task. However, while there are often regulations in place (‘Thinner’ Model MS-7), as were the weight of the
designed to protect adults from injury, it is rare to find students’ schoolbags and the weight of any additional
equivalent regulations in place to protect children or items carried. The electronic scales were calibrated using
adolescents. known weights prior to data collection. The students
The New Zealand Department of Labour Guidelines then answered a questionnaire that enquired about
(1991) specify a relatively high weight limit of 16 kg for musculoskeletal symptoms experienced in the week
workers under 18 years of age, but do not offer immediately preceding data collection. The question-
guidelines for school students. The Manual Handling naire was a modification of the standardised Nordic
Operations Regulations of Great Britain (Health and Musculoskeletal Questionnaire (Kuorinka et al., 1987).
Safety Executive, 1992) contains numerical guidelines A picture of the human body with nine body regions
which are designed to identify those tasks requiring (neck, shoulders, upper arms, lower arms, upper back,
more detailed examination, but these do not take age lower back, hips/thighs, knees, lower legs) (adapted
into account. Recognising that there were no maximum from Corlett and Bishop, 1976) was provided. The
weight regulations relating specifically to load carriage students were asked to answer ‘yes’ or ‘no’ to the
in school students, the National Back Pain Association question, ‘‘Have you, at any time in the last 7 days had
created some guidelines. They suggest that ideally a any ache, pain, discomfort or numbness that may be as a
schoolbag should weigh no more than 10% of a result of your schoolbag(s)?’’ for each of the nine body
student’s body weight (National Back Pain Association, regions. The prevalence of musculoskeletal symptoms
1997), and this weight should be supported on both overall, as well as for all nine body regions, was
shoulders in a backpack style schoolbag. recorded. Some of these body areas were combined to
Although musculoskeletal symptoms in school stu- determine the prevalence of symptoms in the upper body
dents are believed to be multifactorial in origin (Balague (combination of ‘neck’, ‘shoulders’ and ‘upper back’).
et al., 1988), the carriage of heavy schoolbags is a Statistical analysis of the data was performed with
suspected factor in the aetiology of musculoskeletal pain SPSS (1998) and SAS (1996). Calculations were made
in this age group (Burton et al., 1996; Troussier et al., for the whole sample and for the subgroups of third
1994). Certainly the transportation of schoolbags is a form students, sixth form students, females, males, third
task which repeatedly loads the musculoskeletal system, form females, third form males, sixth form females and
and this load bearing could contribute to the production sixth form males. Heights and weights were compared
of pain in this population. As the potential for injury using analysis of variance. The incidence of symptoms in
resulting from schoolbag carriage may be considerable, particular locations was compared between four of the
the present study investigated the weights of schoolbags subgroups (third form boys, third form girls, sixth form
and the prevalence of musculoskeletal symptoms boys and sixth form girls) using logistic regression.
amongst secondary students from five New Zealand Further logistic regressions were used to test whether
schools. carrying heavier bags increased the risk of musculoske-
letal pain. Third and sixth formers were analysed
separately. No further statistical tests were performed.
2. Methods Statistically significant differences were accepted at the
5% level of probability (po0:05).
One hundred and forty secondary school students (70
third form students comprising 35 females and 35 males,
and 70 sixth form students comprising 35 females and 35 3. Results
males) were randomly selected from five Auckland
schools to participate in this study. These schools were The mean (SD) age, height and body weight (BW) of
randomly selected from a list of co-educational second- the third form students (13.6(1.3) years, 162.7(7.8) cm
ary schools from the Auckland region in order to obtain and 54.7(11.7) kg, respectively) was significantly lower
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J. Whittfield et al. / Applied Ergonomics 36 (2005) 193–198 195

than the sixth form students (17.1(0.6) years, When a combination of body locations were explored, it
169.4(9.3) cm and 62.9(12.5) kg, respectively). was found that 72.9% of students reported symptoms in
The mean (SD) schoolbag weight for all of the at least one area of their upper body (Table 3).
students was 6.6(2.2) kg (Table 1), 7.0(2.4) kg for the Third form females recorded the highest prevalence of
third form students and 6.3(2.0) kg for the sixth form musculoskeletal symptoms with 85.7%. Upper back
students. Although there were no statistically significant pain was reported by females (third form 51.4%; sixth
differences between third and sixth formers and between form 40.0%) more than by males (third form 22.9%;
males and females for absolute mean schoolbag weights, sixth form 31.4%) (p ¼ 0:022). Similarly, musculoskele-
when expressed as a percentage of body weight (%BW), tal symptoms in the neck tended to be reported by
schoolbags were significantly (po0:001) heavier (by females (third form 51.4%; sixth form 51.4%) more
2.9%BW) for third formers (13.2%, SD 4.7) than for than by males (third form 37.1%; sixth form 37.1%)
sixth formers (10.3%, SD 3.5) (Table 2). The mean (SD) (p ¼ 0:088). Third formers (females 74.3%; males
schoolbag weight for all of the students was 57.1%) reported marginally more shoulder symptoms
11.7(4.3)%BW. Male third formers carried 3.8%BW than sixth formers (females 54.3%; males 45.7%)
more than male sixth formers (po0:001), whilst female (p ¼ 0:059), and the incidence of low back pain was
third formers carried 2.0%BW more than female sixth marginally higher amongst sixth formers (females
formers (po0:05). There were no statistically significant 45.7%; males 40.0%) than third formers (females
differences in the percentage of body weight carried 28.6%; males 25.7%) (p ¼ 0:051).
between males and females for either the third or the Generally, no link was found between the weight of
sixth form students, nor was there any statistically the bag carried and the incidence of pain. The one
significant difference between males and females for all exception was upper back pain in third formers which
of the students combined. was more common amongst children with heavier bags.
77.1% of students reported experiencing some type of
musculoskeletal symptom during the week preceding
data collection, which they felt may be attributable to 4. Discussion
schoolbag carriage. The prevalences of symptoms
according to location were as follows: neck (44.3%), 4.1. Schoolbag weight
shoulders (57.9%), upper arms (15.7%), lower arms
(7.1%), upper back (36.4%), lower back (35.0%), hips/ The major finding of this study was that third form
thighs (6.4%), knees (5.7%) and lower legs (5.7%). students, in spite of their smaller height and weight,

Table 1
Mean (SD) schoolbag weight for 140 secondary school students (kg)

All Female (f) Male (m) (f)–(m) p

N Mean (SD) n Mean (SD) n Mean (SD)

All 140 6.6(2.2) 70 6.5(2.1) 70 6.8(2.4) 0.3 NS


3rd Form (3) 70 7.0(2.4) 35 6.7(2.2) 35 7.3(2.6) 0.6 NS
6th Form (6) 70 6.3(2.0) 35 6.3(2.0) 35 6.3(2.1) 0 NS
(3)–(6) 0.7 0.4 1.0
p NS NS NS

NS ¼ not significant.

Table 2
Percentage of body weight carried (schoolbag weight/body weight) by 140 secondary school students (%BW)

All Female (f) Male (m) (f)–(m) p

n Mean (SD) n Mean (SD) n Mean (SD)

All 140 11.7(4.3) 70 12.0(4.2) 70 11.5(4.5) 0.5 NS


3rd Form (3) 70 13.2(4.7) 35 13.0(4.6) 35 13.4(4.7) 0.4 NS
6th Form (6) 70 10.3(3.5) 35 11.0(3.4) 35 9.6(3.4) 1.4 NS
(3)–(6) 2.9 2.0 3.8
p o0.001 o0.05 o0.001

NS ¼ not significant.
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Table 3
Prevalence of musculoskeletal symptoms in each body location for the subgroups of third form females, third form males, sixth form females and
sixth form males (%)

BODY REGION ALL 3rd Form 6th Form

Females Males Females Males

N 140 35 35 35 35
Any location 77.1% 85.7% 74.3% 74.3% 74.3%
Neck 44.3% 51.4% 37.1% 51.4% 37.1%a
Shoulders 57.9% 74.3% 57.1% 54.3% 45.7%b
Upper arms 15.7% 17.1% 14.3% 14.3% 17.1%
Lower arms 7.1% 5.7% 11.4% 5.7% 5.7%
Upper back 36.4% 51.4% 22.9% 40.0% 31.4%c
Lower back 35.0% 28.6% 25.7% 45.7% 40.0%d
Hips/thighs 6.4% 5.7% 5.7% 11.4% 2.9%
Knees 5.7% 5.7% 8.6% 5.7% 2.9%
Lower legs 5.7% 8.6% 5.7% 2.9% 5.7%
Upper body 72.9% 80.0% 71.4% 71.4% 68.6%
a
Incidence marginally higher amongst females (p ¼ 0:088).
b
Incidence marginally higher amongst third formers (p ¼ 0:059).
c
Incidence significantly higher amongst females (p ¼ 0:022).
d
Incidence marginally higher amongst 6th formers (p ¼ 0:051).

carried heavier schoolbags than sixth form students. comparable to those of trained soldiers, is a cause for
This may be due in part to the greater number of serious concern.
subjects taken at school by the younger age group The New Zealand Department of Labour (1991)
(Ministry of Education, 1993), or may reflect the acknowledges that young workers are at greater risk of
inexperience or inability of this age group in deciding manual handling injuries than adults are because they
the necessary books or supplies to take to school. It may are still developing physically. In their 1991 guidelines,
even be reflective of the availability of lockers at school the Department of Labour cite a weight limit of 16 kg
for these students. for workers less than 18 years. Although this figure is
When schoolbag weight was expressed as a percentage heavier than the schoolbag weights found in this study,
of body weight, the results here (13.2% for third formers but it must be noted that it is not based on objective
and 10.3% for sixth formers) were similar to those of the epidemiological data with respect to safety for this age
National Back Pain Association (1997) who found that group, nor does it indicate any guidelines as to
13-year-old students carried 10.4% of their body weight frequency of lifts.
and 16-year-old students carried 10.2%. Voll and Klimt In the UK, the Manual Handling Operations Regula-
(1977) also recorded similar loads (11.1%–14.3%) tions (Health and Safety Executive, 1992) set no specific
carried by German school children in Grades 1–4. Both weight limits, but does contain numerical guidelines
of these studies include the recommendation that school which provide an initial filter to identify those tasks
children should carry no more than 10% of their body which warrant more detailed assessment. However,
weight. Although we know of no prospective epidemio- these guidelines are designed to be applied to adult
logical study that specifically supports this recommen- workers only. If we apply these guidelines to the task of
dation, it does not in itself seem unreasonable given the lifting a schoolbag from the floor, the guideline weight
present state of knowledge. The mean schoolbag weight can be calculated to be 4.5 kg. This figure is far lower
in our study was 11.7% of body weight, and it can than the weights that were observed in the present study
therefore be seen that the student groups in our study (7.0 kg for third formers and 6.3 kg for sixth formers)
exceeded the recommended limit of 10% of body weight. which means that we are expecting school students to lift
The most extreme case in this study was a third form more than the recommended adult value.
male student weighing 50 kg, who carried 27.0% of his
body weight. This consisted of a schoolbag weighing 4.2. Musculoskeletal symptoms
9.5 kg, and an additional bag weighing 4.0 kg. This
figure is close to the traditionally accepted value of one- In the present study, 77.1% of students reported
third of body weight as the upper backpack load limit experiencing musculoskeletal symptoms in at least one
carried by soldiers on marches (Legg, 1985). That some part of their bodies in the week immediately preceding
13-year-old students are transporting relative loads the administration of the questionnaire. This is an
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J. Whittfield et al. / Applied Ergonomics 36 (2005) 193–198 197

unexpectedly high value but is likely to be due in part to symptoms may result from an ergonomic approach
the way in which the question was posed. The to this working system including reducing the load
questionnaire was deliberately leading in nature as it carried by students, schoolbag redesign, curriculum
asked students to report any ache, pain, discomfort or planning and training. No single option will necessarily
numbness experienced which may be due to the use of reduce the incidence of musculoskeletal symptoms but
schoolbags. This style of questioning was chosen as we a combination is likely to help counter the overall risk
discovered in pilot trials that non-specific questioning of injury.
frequently failed to provide information about the
relationship between musculoskeletal symptoms and
the carriage of schoolbags but rather often indicated 5. Conclusions
the musculoskeletal symptoms due to factors such as ill-
fitting school furniture and sports injuries. This high It is concluded that third form students carry heavier
value may also have been due to the assumption of some schoolbags than sixth form students and that the weight
students that their results could lead to the provision of of schoolbags carried by secondary school students (at
lockers in their schools. Thus, we do not know by how least in five Auckland schools) may exceed the
much our approach may have inflated the apparent recommended guideline load weights for adult industrial
prevalence of musculoskeletal symptoms. Nevertheless, workers. There appeared to be a very high self-reported
we believe that it is essential that this issue be explored prevalence of musculoskeletal symptoms amongst this
more fully. Specifically, we recognise the need to group of students, but this may have been influenced by
question the acceptability of self-reporting of symptoms methodological factors and would warrant further
in this age group without physical examination to investigation in the future. Although musculoskeletal
support the findings. symptoms are believed to be multifactorial in origin, the
In this study, neck and upper back symptoms were carriage of heavy schoolbags is clearly a suspected
found to be more common amongst females than males. contributory factor and may represent an overlooked
A plausible explanation for this is that females tend to daily physical stress for New Zealand secondary school
have lower muscle strength than males, particularly in students. Future work in secondary schools is required
the upper limb musculature (Haisman, 1988). to confirm these results. In particular, longitudinal
Low back pain was reported by 35.0% of students population studies on the risk factors for musculoske-
overall. Sixth form students reported more low back letal pain in secondary school students are needed.
symptoms (42.9%) than third form students (27.1%).
These figures are very high when compared to the point
prevalence of low back pain in nurses (which is known Acknowledgements
to be a high-risk profession) of 16.8% (Magora, 1970)
and 17.0% (Pheasant and Stubbs, 1992). Troup (1965) This study was conducted in partial fulfilment of the
suggests that a possible mechanism of back pain may be requirements for the degree of Master of Science (Health
that an accumulation of minor strains hastens spinal Ergonomics) from the University of Surrey, Guildford,
degeneration. Therefore, it may be that by the time UK. The principal author wishes to acknowledge the
students reach the sixth form, some damage due to support and guidance provided by Dr. Ted Lovesey of
minor strains imposed by schoolbag carriage may have The University of Surrey, as well as thanking the
already occurred. principals, staff, schoolchildren (and their parents) from
the Auckland schools for their enthusiasm and whole-
4.3. Implications hearted support for this study.

The carrying, lifting and manipulating of heavy


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